1. USING Guttmacher Institute PRESENTATION TOOLS
This presentation contains complete reference information in the notes section of each slide, as well as accompanying speaking notes.
To access speaking notes, references and data points:
Step 1: Download presentations as PowerPoint (not PDF)
Step 2: On the toolbar, choose [Edit], then choose [Edit Slides]. This will reveal the PowerPoint menu options.
Step 3a: To view speaking notes and references, choose [View] on the toolbar, then choose [Notes Page].
Step 3b: To view data points on chart slides, double-click on the chart. A small table showing all the underlying numbers will pop up.
Policy for download:
Guttmacher presentation tools are made available for general use with the understanding that the information presented will not be altered in any way. You may choose to present selected slides from the presentation or incorporate slides into other presentations. However, by changing the text, data or references contained on the individual slides you violate the Institute’s copyright.

2. Sex Education: Needs, Programs and Policies
The Guttmacher Institute
© July 2005
This presentation from The Guttmacher Institute brings together the latest information about sex education in the United States as it relates to the prevention of unintended pregnancies and sexually transmitted diseases (STDs). It includes background information about sexual activity among American youth, sex education policy and practice in public schools, the effectiveness of programs designed to delay sexual activity and to prevent unintended pregnancy and STDs among teenagers, and the disconnect between public opinion and public policy in this area.
Note: These slides were updated in July 2005 to reflect new research and data.

3. The Need to Help Young People Make Healthy Decisions
There is a clear need to help young people make healthy decisions regarding sexual activity so that they can protect themselves from unintended pregnancy and STDs.

4. Young people are at high risk of unintended pregnancy and STDs for many years
Intend no more children
First intercourse
Spermarche
First marriage
First birth
MEN
14.0
16.9
26.7
28.5
33.2
AGE
The period of time during which young people are at greatest risk of unintended pregnancy and STDs spans many years.
Most young people enter puberty in early adolescence—around age 13 for women and age 14 for men. They typically have sexual intercourse for the first time around age 17, but do not marry until their middle to late 20s. This means that they are at high risk of unintended pregnancy and STDs for almost a decade before marriage, at which point their risk diminishes but does not disappear.
Sources: Guttmacher Institute, In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men, New York: Guttmacher Institute, 2002, p. 8; and Dailard C, Marriage is no immunity from problems with planning pregnancies, The Guttmacher Report on Public Policy, 2003, 6(2):10-13.
12.6
17.4
25.1
26.0
30.9
WOMEN
Menarche
First intercourse
Intend no more children
First marriage
First birth

5. Many teenagers experience pregnancy and STDs
More than 800,000 women younger than 20 become pregnant each year
80% of these pregnancies are unintended
Nine million teenagers and young adults acquire an STD each year
Two young people every hour become infected with HIV
Each year, more than 800,000 teenage women become pregnant, and about 80% of these pregnancies are unintended. In addition, an estimated nine million teenagers and young adults acquire an STD each year.
Half of the 30,000 new sexually transmitted cases of HIV infection in the United States each year occur among individuals younger than 25. That means that every hour of every day, an average of two young people become infected with HIV.
Note: These slides were updated in April 2004 to reflect new teenage pregnancy and STD data.
Sources: Henshaw SK, U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24, New York: Guttmacher Institute, February, 2004, < accessed Apr. 8, 2004; Henshaw SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1998, 30(1):24-29 & 46; and Weinstock H, et al., Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000, Perspectives on Sexual and Reproductive Health, 2004, 36(1):6-10.

6. The teenage pregnancy rate is going down
The good news, however, is that the teenage pregnancy rate in this country is down 28% since its peak in 1990, and is at its lowest level in 30 years.
Note: These slides were updated in April 2004 to reflect new teenage pregnancy and STD data.
Source: Henshaw SK, U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24, New York: Guttmacher Institute, February 2004, < accessed Apr. 8, 2004.

7. 47% of the decline was due to more effective contraceptive use
Both abstinence and contraceptive use are responsible for the decline in teenage pregnancy
53% of the decline was due to more teens choosing to delay sexual activity
47% of the decline was due to more effective contraceptive use
A growing body of research suggests that both increased abstinence and changes in contraceptive practice are responsible for the decline in teenage pregnancy.
For example, a 2004 analysis by researchers at the Centers for Disease Control and Prevention found that approximately half of the decline in teenage pregnancy between 1991 and 2001 was due to more teenagers choosing to delay sexual activity.
The other half resulted from a decrease in pregnancy rates among sexually experienced teenagers. This decline was caused by more effective contraceptive use, resulting from fewer teens using no method of contraception, declining use of withdrawal and increased use of condoms.
Source: Santelli JS et al., Can changes in sexual behaviors among high school students explain the decline in teen pregnancy rates in the 1990s?, 2004, Journal of Adolescent Health, 35(2):80-90.

8. The proportion of high school students who have had sex has declined
Between 1991 and 2003, the proportion of high school students who had ever had sex declined by 16% for males and 10% for females.
Source: Brener N et al., Trends in sexual risk behaviors among high school students—United States, , Morbidity and Mortality Weekly Report, 2002, 51(38): ; and Grunbaum J et al., Youth Risk Behavior Surveillance, United States, 2003, Morbidity and Mortality Weekly Report, 2004, 53(SS-2).

9. The proportion of sexually active high school students who use condoms has risen
The proportion of teenagers who had had sex decreased between 1991 and 2003, and condom use among sexually active teenagers increased during that period by 26% for males and 51% for females.
Note: This slide was updated in December 2004 to reflect new YRBS data for 2003.
Source: Brener N et al., Trends in sexual risk behaviors among high school students—United States, , Morbidity and Mortality Weekly Report, 2002, 51(38): ; and Grunbaum J et al., Youth Risk Behavior Surveillance, United States, 2003, Morbidity and Mortality Weekly Report, 2004, 53(SS-2).

10. U.S. teenagers have higher rates of pregnancy, birth and abortion than teenagers in most other developed countries
Notes: Teenage pregnancy rate=number of births and abortions per 1,000 women aged Pregnancies do not include miscarriages. Data are for the mid-1990s.
Nonetheless, more progress is needed. Teenagers in the United States fare worse as a result of their sexual activity than do teenagers in most other developed countries. U.S. teenagers have much higher pregnancy rates, birthrates and abortion rates. They also have higher rates of STDs.
Sources: Guttmacher Institute, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: Guttmacher Institute, 2001, No. 3; and Guttmacher Institute, Fulfilling the Promise: Public Policy and U.S. Family Planning Clinics, New York: Guttmacher Institute, 2000.

11. Why Do U.S. Teenagers Fare Worse Than Teenagers in Other Developed Countries?

12. Levels of teenage sexual activity across developed countries are similar…
Note: Data are for the mid-1990s.
A common misperception is that teenagers in this country begin having sex at an unusually early age and have especially high rates of sexual activity. But research comparing adolescents in the United States with adolescents in similar developed nations shows that this is not true. By and large, American teenagers behave in much the same way as their counterparts in other countries in terms of their age at initiation of sex and their levels of sexual activity.
Source: Guttmacher Institute, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: Guttmacher Institute, 2001, No. 3.

13. Are less likely to use contraceptives Have shorter relationships
…but U.S. teenagers have higher rates of unintended pregnancy and STDs because they
Are less likely to use contraceptives
Have shorter relationships
Have more sexual partners
In comparison with their peers in other developed countries, sexually active teenagers in the United States are less likely to use contraceptives. When they do, they are less likely than teenagers in other countries to use the pill or other highly effective hormonal methods, possibly because they have shorter relationships.
The fact that U.S. teenagers have shorter relationships and, consequently, more sexual partners over time also increases their risk for STDs.
Source: Guttmacher Institute, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: Guttmacher Institute, 2001, No. 3.

14. Clear and unambiguous prevention messages
What accounts for lower teenage pregnancy and STD rates in other countries?
Clear and unambiguous prevention messages
Expectation that childbearing will be delayed until adulthood
Societal supports for young people
There is evidence that in many developed countries with low levels of teenage pregnancy, childbearing and STDs, adults tend to be more accepting of sexual activity among teenagers than are adults in the United States. However, adults in these countries also give clear and unambiguous messages that sex should occur within committed relationships and that sexually active teenagers are expected to take steps to protect themselves and their partners from pregnancy and STDs.
Moreover, while these societies may be more accepting of teenage sex than the United States, they are, in fact, less accepting of teenage parenthood. Strong societal messages convey that childbearing should occur only in adulthood, which is considered to be when young people have completed their education, are employed and are living in stable relationships. Societal supports exist to help young people with the transition to adulthood, through vocational training, education and job placement services, and child care. As a result, teenagers have positive incentives to delay childbearing.
Sources: Guttmacher Institute, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: Guttmacher Institute, 2001, No. 3; and Boonstra H, Teen pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002, 5(1):7-10.

15. Greater access to contraceptive and reproductive health services
What accounts for lower teenage pregnancy and STD rates in other countries?
Greater access to contraceptive and reproductive health services
Comprehensive sex education
Teenagers in other developed countries also have greater access to contraceptives and reproductive health services than teenagers in the United States, and they are provided with comprehensive education about pregnancy and STD prevention in schools and community settings. In contrast, sex education that exclusively promotes abstinence is common in U.S. public schools.
Sources: Guttmacher Institute, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: Guttmacher Institute, 2001, No. 3; and Boonstra H, Teen pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002, 5(1):7-10.

16. Sex Education in U.S. Public Schools
Sex education can play a major role in helping teenagers to make healthy and responsible decisions about sex, but the content of sex education varies tremendously. Currently, 39 states mandate either sex education or education on HIV/AIDS and other STDs, but their laws tend to be very general. Policies specifying the content of sex education classes are typically set at the local level, and local school districts tend to have broad discretion in this area.
Sources: Guttmacher Institute, Sexuality education, State Policies in Brief, July 2003, < accessed Feb. 15, 2005; and Gold RB and Nash E, State-level policies on sexuality, STD education, The Guttmacher Report on Public Policy, 2001, 4(4):4-7.

17. Most school district policies promote abstinence
Today, more than two out of three public school districts have a policy of teaching sex education. Most adopted their current policies during the mid-1990s. During this time, many state governments and local communities were experiencing heated debates over the content of sex education curricula.
School districts with a sex education policy universally require that abstinence be taught, and 86% require that abstinence be promoted over other options for teenagers. Some 35% require that abstinence be taught as the only option for unmarried people, and either do not allow discussion of contraceptives or allow discussion only of their failure rates. The other 51% require that abstinence be taught as the preferred option for young people, but also permit discussion about contraception as an effective means of protecting against unintended pregnancy and STDs.
Only 14% have a policy of teaching abstinence as part of a broader program designed to prepare adolescents to be sexually healthy adults.
Source: Landry DJ, Kaeser L and Richards CL, Abstinence promotion and the provision of information about contraception in public school district sexuality education policies, Family Planning Perspectives, 1999, 31(6):
Districts with a sex education policy

18. School district sex education policies vary widely by region
There is significant regional variation in school district sex education policies. More than half of school districts in the South have a policy of teaching that abstinence is the only option for teenagers, compared with 20% of districts in the Northeast.
The trend in school district policy is toward abstinence promotion. Districts that switched their policies during the 1990s were twice as likely to adopt a more abstinence-focused policy as to move toward a more comprehensive approach.
Source: Landry DJ, Kaeser L and Richards CL, Abstinence promotion and the provision of information about contraception in public school district sexuality education policies, Family Planning Perspectives, 1999, 31(6):

19. There is a large gap between what teachers believe should be covered in sex education and what they actually teach
Not surprisingly, the emphasis on abstinence in sex education policies influences what is being taught in sex education classes. In certain areas of sex education, there is a large gap between what teachers believe they should cover and what they are actually teaching. The great majority of sex education teachers believe that sex education should cover factual information about birth control and abortion, the correct way to use a condom, and sexual orientation. However, far fewer actually teach these topics, either because they are prohibited from doing so or because they fear teaching these topics would create controversy.
As a result, one in four teachers believe they are not meeting their students’ needs for information.
Source: Darroch JE, Landry DJ and Singh S, Changing emphasis in sexuality education in U.S. public secondary schools, , Family Planning Perspectives, 2000, 32(5): & 265.

20. Many sex education teachers do not teach about contraception
One in four sex education teachers are prohibited from teaching about contraception
Four in 10 either do not teach about contraceptive methods (including condoms) or teach that they are ineffective
The gap between what sex education teachers think should be covered and what they actually teach is particularly acute when it comes to contraception. Sex education teachers almost universally believe that students should be provided with basic factual information about birth control, but school policies prohibit one in four teachers from doing so.
Overall, four in 10 teachers either do not teach about contraceptive methods (including condoms) or teach that they are ineffective in preventing pregnancy and STDs.
Source: Darroch JE, Landry DJ and Singh S, Changing emphasis in sexuality education in U.S. public secondary schools, , Family Planning Perspectives, 2000, 32(5): & 265.

21. Teachers who teach the effectiveness of contraception are more likely to cover key prevention topics
That four in 10 sex education teachers either do not teach about contraceptives at all or teach that they are ineffective in preventing pregnancy and STDs is particularly troubling. New research shows that teachers who present contraception as effective are more likely than those who present it as ineffective to provide young people with specific information about topics key to the prevention of unintended pregnancy and STDs, including the importance of using contraceptives consistently, the use of condoms to prevent STD/HIV infection and where to obtain STD/HIV help.
Source: Landry DJ et al., Factors associated with the content of sex education in U.S. public secondary schools, Perspectives on Sexual and Reproductive Health, 2003, 35(6):

22. Public Opinion

23. Americans overwhelmingly favor broader sex education
93% of parents reported their child has benefited from sex education
94% of parents say that sex education should cover contraception
Only 15% of Americans want abstinence-only education taught in the classroom
What many students are being taught in sex education classes does not reflect public opinion about what they should be learning. Americans overwhelmingly support sex education that includes information about both abstinence and contraception. Moreover, public opinion polls consistently show that parents support this kind of sex education over classes that teach only abstinence.
Some 93% of parents whose children have taken sex education believed it was very or somewhat helpful for their child in dealing with sexual issues. In addition, 94% of parents say that sex education should cover contraception, and 87% say that sex education should cover how to use and where to get contraception. Only 15% believed that only abstinence should be taught.
Note: This slide was updated in July 2005 to reflect new data.
Source: The Henry J. Kaiser Family Foundation (KFF), National Public Radio and John F. Kennedy School of Government, Sex Education in America, Menlo Park, CA: KFF, 2004.

24. Many teenage males do not receive sex education before first sex
Yet many students are receiving sex education too late to fully protect themselves against unintended pregnancy and STDs – or are not receiving it at all. For example, in 2002, one-third of teens reported having received no school-based sex education about contraceptive methods before age 18.
At the same time, many teens are not getting this information from their parents: only half of young women ages 18-19, and just over one-third of men this age, say they had talked with a parent about contraception before they turned 18.
Source: Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002, National Center for Health Statistics, 2004, Vital and Health Statistics, 23(24).

25. Students say they need more sex education in school than they currently receive
It is therefore not surprising that students report that they want more information about sexual and reproductive health issues than they are receiving in school. Some 40-50% of students in grades 7-12 report wanting more factual information about birth control and HIV/AIDS and other STDs, as well as what to do in the event of rape or sexual assault, how to talk with a partner about birth control and how to handle pressure to have sex.
Source: The Henry J. Kaiser Family Foundation (KFF), National Public Radio and the John F. Kennedy School of Government, Sex Education in America, Menlo Park, CA: KFF, 2000.

26. Support for comprehensive sex education
American Medical Association
American Academy of Pediatrics
American Nurses Association
American College of Obstetricians and Gynecologists
American Psychological Association
American Public Health Association
National Institutes of Health
Institute of Medicine
Major medical and public health organizations also support more comprehensive forms of sex education that include information about both abstinence and contraception for the prevention of teenage pregnancy and STDs. These include the American Medical Association, the American Academy of Pediatrics, the American Nurses Association, the American College of Obstetricians and Gynecologists, the American Psychological Association, the American Public Health Association, the National Institutes of Health and the Institute of Medicine.
Source: Boonstra H, Legislators craft alternative vision of sex education to counter abstinence-only drive, The Guttmacher Report on Public Policy, 2002, 5(2):1-3.

27. The Big Disconnect
Teachers, parents, students and health organizations want young people to receive comprehensive sex education.
Conservative groups and politicians are promoting education in U.S. schools that emphasizes abstinence and denies young people accurate information about contraception.
A growing body of research therefore highlights a troubling disconnect: Although teachers, parents, students and health organizations want young people to receive more comprehensive information about how to avoid unintended pregnancy and STDs and about how to become sexually healthy adults, U.S. policymakers continue to promote school-based abstinence education that fails to provide accurate information about contraception, including condoms.
Source: Dailard C, Sex education: politicians, parents, teachers and teens, The Guttmacher Report on Public Policy, 2001, 4(1):9-12; and Boonstra H, Legislators craft alternative vision of sex education to counter abstinence-only drive, The Guttmacher Report on Public Policy, 2002, 5(2):1-3.

28. U.S. Government Support for Abstinence Education

29. The Federal Definition of Abstinence Education
“Abstinence education…has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity”
Beginning in 1981, the federal government provided funding on a small scale for education that promoted abstinence. Under the 1996 welfare reform law, however, it committed $50 million a year in federal funding and required another $38 million in state matching funds to support abstinence education.
The 1996 law established a stringent eight-point definition of “abstinence education” that requires funded programs to teach that sexual activity outside of marriage is wrong and harmful—for people of any age. Funded programs must exclusively promote abstinence. As a result, they are prohibited from advocating contraceptive use. They must either refrain from discussing contraceptive methods altogether or limit their discussion to contraceptive failure rates.
This eight-point definition represents the only articulation of sex education policy in federal law.
Source: P.L , Aug. 22, 1996.

30. Total Federal Funding for Abstinence Education—FY 2005
Welfare: $50 million
AFLA: $13 million
CBAE: $104 million
Total: $167 million
Since 1996, Congress has also supported abstinence education that omits accurate information about contraception through two other funding streams, both of which use the welfare law’s eight-point definition. For 2005, Congress provided $13 million for abstinence education through the Adolescent Family Life Act (AFLA) and $104 million for Community Based Abstinence Education (CBAE).
Among these three programs, the federal government devoted $167 million to abstinence education in 2005.
Note: Updated July 2005.
Source: Dailard C, Abstinence promotion and teen family planning: the misguided drive for equal funding, The Guttmacher Report on Public Policy, 2002, 5(1):1-3.

31. Funding for abstinence-only sex education has increased substantially
Funding $ in millions
The current $167 million funding level for abstinence education that excludes complete and accurate information about contraception represents a dramatic increase over the mere $10 million spent in 1997.
Note: Updated July 2005.
Source: Unpublished tabulations by the Guttmacher Institute based on annual federal government appropriations for abstinence-only sex education.

32. Federally funded abstinence education programs mislead youth
Contraceptive effectiveness
Risks of abortion
STD incidence and transmission
Scientific facts
Medical evidence
However, a December 2004 federal report shows that the most widely-used federally-funded abstinence education curricula contain pervasive errors and misinformation on a wide range of important sexual and reproductive health issues, including
grossly underestimating the effectiveness of condoms and other contraceptives in preventing pregnancy and STDs;
making false claims about the physical and psychological risks of abortion;
offering misinformation on the incidence and transmission of STDs;
replacing scientific facts with religious views and moral judgments; and
distorting medical evidence and basic scientific facts.
Note: Updated July 2005
Source: United States House of Representatives, Committee on Government Reform – Minority Staff, Special Investigations Division, Prepared for Rep. Henry A. Waxman, The Content of Federally Funded Abstinence-Only Education Programs, December 2004.

33. The Grand Total
Federal and matching state funding for abstinence education that fails to include accurate and complete information about contraception has topped $1 billion since 1996.
Note: Updated July 2005
Source: Dailard C, Funding history for abstinence programs, memorandum, Washington, DC: Guttmacher Institute, 2005.

34. Effectiveness of Sex Education

35. What do evaluations say about the effectiveness of sex education?
No evidence shows that abstinence without contraceptive education effectively protects teenagers
Contraceptive education does not encourage sexual activity
Despite at least two decades of abstinence education, there have been few rigorous evaluations to date of programs focusing exclusively on abstinence. Moreover, none of these has shown evidence that these programs either delay sexual activity or reduce teenage pregnancy.
Program evaluations clearly show, however, that contraceptive education does not promote sexual activity among teenagers. These results refute long-standing claims by proponents of abstinence education that providing teenagers with information about the value of both abstinence and contraceptive use sends “mixed messages” that encourage sexual activity.
Sources: Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001; and Satcher D, The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, Rockville, MD: Office of the Surgeon General, 2001.

36. What do evaluations say about the effectiveness of sex education?
Considerable evidence that certain programs that include abstinence and contraceptive education help teenagers
delay sexual activity
increase contraceptive use
reduce number of partners
Furthermore, there is considerable scientific evidence that certain programs that include information about both abstinence and contraception help teenagers delay sexual activity. Teenagers who have participated in these more comprehensive programs also demonstrate increased contraceptive use and have fewer sexual partners when they do become sexually active than teenagers who have participated in programs focused exclusively on abstinence.
Sources: Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001; and Satcher D, The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, Rockville, MD: Office of the Surgeon General, 2001; and Manlove J, Romano-Paillio A and Ikramullah E, Not Yet: Programs to Delay First Sex Among Teens, Washington, DC: National Campaign to Prevent Teen Pregnancy.

37. The Potential for Harm
Virginity pledges help some teens to delay sexual activity, BUT
Most pledgers break their pledge, AND
Pledge-breakers are:
Less likely to use condoms or seek STD care
More likely to engage in alternative sexual behavior
Research suggests that education and strategies that promote abstinence but withhold information about contraceptives in general, and condoms in particular, can actually place young people at increased risk of pregnancy and STDs.
For example, research shows that the “virginity pledges” at the heart of many abstinence-education programs can help some teenagers to delay sex an average of 18 months. However, most pledgers break their pledge and have sex before marriage. Those teens are less likely to use condoms than their peers who never pledged in the first place. They are also less likely to get tested and treated for STDs, and may have STDs for longer periods of time than non-pledgers.
Finally, pledging may lead some teens and young adults to engage in risky alternatives to vaginal intercourse, such as oral and anal sex, to preserve their virginity.
Note: Updated July 2005
Sources: Bearman PS and Bruckner H, Promising the future: virginity pledges and first intercourse, American Journal of Sociology, 2001, 106(4): ; Bruckner H and Bearman PS, After the promise: the STD consequences of adolescent virginity pledges, Journal of Adolescent Health, 2005, 36:

38. The Potential for Harm
HIV prevention messages that promote only abstinence and not condoms may result in more unprotected sex than do safer-sex messages.
Another study found that sexually experienced teenagers who received messages promoting only abstinence for HIV prevention were more likely to have unprotected sex than those who received safer-sex messages emphasizing abstinence, but advising condom use for teenagers who are sexually active.
More research needs to be done to determine how long these negative effects last, and their potential impact on pregnancy and STD/HIV risk.
Note: Updated July 2005
Jemmott JB, Jemmott LS and Fong GT, Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial, Journal of the American Medical Association, 1998, 279(19): ;

39. In Conclusion…

40. A “risk reduction” approach to teenage sexual activity remains vital
Sex among young people is common in the United States and worldwide
Undermining confidence in contraception threatens young people’s lives and health
Providing teens with medically accurate information reduces their risk of STDs and unwanted pregnancies
The promotion of abstinence education that questions the effectiveness of contraceptives in general, and condoms in particular, is at the heart of a socially conservative movement to undermine the validity of “risk reduction” as a public health paradigm. Proponents of this view say that only complete “risk elimination” through abstinence until marriage to an uninfected partner and mutual lifelong monogamy offers total protection from STDs. Furthermore, they say that this is the only prevention message that should be provided to young people.
Yet sex among young people, and unmarried people of all ages, is common—both in this country and around the world. Thus, undermining people’s confidence in the effectiveness of contraceptives, including condoms, threatens their health and lives.
Providing young people with balanced and accurate information about contraception as part of basic sex education must therefore remain a key component of public health efforts to help young people protect themselves against unintended pregnancies and STDs.
Source: Boonstra H, Public health advocates say campaign to disparage condoms threatens STD prevention efforts, The Guttmacher Report on Public Policy, 2003, 6(1):1-2 & 14.

41. Summary Many U.S. teenagers experience unintended pregnancy and STDs
Teenagers in other developed countries fare better
Abstinence education that omits accurate information about contraceptives is prevalent across the country
Many sex education teachers believe they are not meeting students’ needs
In summary, too many young people in this country experience poor sexual and reproductive health outcomes, including unintended pregnancy and STDs. Individuals and organizations working to improve the health and welfare of young people can learn from the experience of other developed countries, where young people have significantly lower rates of unintended pregnancy and STDs.
In contrast to schools in these other countries, where sex education includes comprehensive information about pregnancy and STD prevention, U.S. schools commonly provide abstinence education that either excludes information about or denigrates contraception. As a result, many sex education teachers believe they are not meeting their students’ needs for information.

42. Summary
Current federal policy ignores public opinion and research on “what works”
Only a balanced and comprehensive approach will help teenagers to become sexually healthy adults
By promoting abstinence education that omits accurate and complete information about contraception, U.S. policy ignores the experience of other countries, public opinion and research on “what works.”
Preserving and continuing the gains of the last decade requires a balanced approach that emphasizes all the key means of prevention—including effective contraceptive and condom use, as well as abstinence. Ultimately, only such a comprehensive approach will provide young people with the tools they need to protect themselves and to become sexually healthy adults.

43. Major Sources National Surveys
Youth Risk Behavior Survey–Centers for Disease Control and Prevention
National Survey of Family Growth– National Center for Health Statistics
Surveys of school superintendents and sex education teachers–Guttmacher Institute
Survey of students and public opinion–Henry J. Kaiser Foundation
National Survey of Adolescent Males–Urban Institute
This presentation uses information from a variety of nationally representative surveys from federal and private agencies. The data sources include surveys of school superintendents, teachers, students and the general public. Other data and sources include birth and international abortion statistics from a range of sources, evaluation research results on the effectiveness of sex education programs and policy analyses conducted by Guttmacher staff.

44. Major Sources Other Sources
Teenage pregnancy statistics–Guttmacher Institute
International birth and abortion statistics from various sources
Evaluation research–National Campaign to Prevent Teen Pregnancy
Federal law and policy
Statements on sex education from national organizations
Policy analysis–Guttmacher Institute

45. For more information, visit www.guttmacher.org
This presentation was developed with support from the Program on Reproductive Health and Rights of the Open Society Institute.
For more information, visit
Acknowledgments:
This presentation was prepared by Cynthia Dailard, with the assistance of David Landry, Jennifer Nadeau and Rebecca Wind, all with the Guttmacher Institute. It was supported by a grant from the Program on Reproductive Health and Rights of the Open Society Institute.
The Guttmacher Institute is grateful to the following individuals, who reviewed earlier drafts of this presentation and provided valuable information and advice: Krista Anderson, Planned Parenthood of the Rocky Mountains; Kelson Ettienne-Modest, Weaver High School; Marcela Howell, Advocates for Youth; Douglas Kirby, ETR Associates; Mike McGee, Planned Parenthood Federation of America; Jennifer Parker, ACCESS/Women’s Health Rights Coalition; and Susan Wilson, Rutgers University.

46. References
Slide 3: The Alan Guttmacher Institute (AGI), In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men, New York: AGI, 2002, p. 8; and Dailard C, Marriage is no immunity from problems with planning pregnancies, The Guttmacher Report on Public Policy, 2003, 6(2):10-13.
Slide 4: Henshaw SK, U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24, New York: AGI, May 2003, < accessed July 28, 2003; Henshaw SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1988, 30(1):24-29 & 46; and Centers for Disease Control and Prevention (CDC), Young People at Risk: HIV/AIDS Among America’s Youth, Atlanta: CDC, Mar
Slide 5: Henshaw SK, U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24, New York: AGI, May 2003, < accessed July 28, 2003.
Slide 6: Darroch JE and Singh S, Why Is Teenage Pregnancy Declining? The Roles of Abstinence, Sexual Activity and Contraceptive Use, Occasional Report, New York: AGI, 1999, No. 1.
Slide 7: Brener N et al., Trends in sexual risk behaviors among high school students—United States, , Morbidity and Mortality Weekly Report, 2002, 51(38):
Slide 8: Brener N et al., Trends in sexual risk behaviors among high school students—United States, , Morbidity and Mortality Weekly Report, 2002, 51(38):
Slide 9: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3; and AGI, Fulfilling the Promise: Public Policy and U.S. Family Planning Clinics, New York: AGI, 2000.
Slide 11: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3.
Slide 12: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3.
Slide 13: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3; and Boonstra H, Teen pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002, 5(1):7-10.

47. References
Slide 14: AGI, Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made? Occasional Report, New York: AGI, 2001, No. 3; and Boonstra H, Teen pregnancy: trends and lessons learned, The Guttmacher Report on Public Policy, 2002, 5(1):7-10.
Slide 15: AGI, Sexuality education, State Policies in Brief, July 2003, < accessed July 28, 2003; and Gold RB and Nash E, State-level policies on sexuality, STD education, The Guttmacher Report on Public Policy, 2001, 4(4):4-7.
Slide 16: Landry DJ, Kaeser L and Richards CL, Abstinence promotion and the provision of information about contraception in public school district sexuality education policies, Family Planning Perspectives, 1999, 31(6):
Slide 17: Landry DJ, Kaeser L and Richards CL, Abstinence promotion and the provision of information about contraception in public school district sexuality education policies, Family Planning Perspectives, 1999, 31(6):
Slide 18: Darroch JE, Landry DJ and Singh S, Changing emphasis in sexuality education in U.S. public secondary schools, , Family Planning Perspectives, 2000, 32(5): & 265.
Slide 19: Darroch JE, Landry DJ and Singh S, Changing emphasis in sexuality education in U.S. public secondary schools, , Family Planning Perspectives, 2000, 32(5): & 265.
Slide 20: Landry DJ et al., Factors influencing the content of sex education in U.S. public secondary schools, Perspectives on Sexual and Reproductive Health, 2003, forthcoming.
Slide 22: The Henry J. Kaiser Family Foundation (KFF), Sex Education in America, Menlo Park, CA: KFF, 2000.
Slide 23: The Henry J. Kaiser Family Foundation (KFF), Sex Education in America, Menlo Park, CA: KFF, 2000.
Slide 24: Lindberg LD, Ku L and Sonenstein F, Adolescents’ reports of reproductive health education, , Family Planning Perspectives, 2000, 32(5):

48. References
Slide 25: Boonstra H, Legislators craft alternative vision of sex education to counter abstinence-only drive, The Guttmacher Report on Public Policy, 2002, 5(2):1-3.
Slide 26: Dailard C, Sex education: Politicians, parents, teachers and teens, The Guttmacher Report on Public Policy, 2001, 4(1):9-12; and Boonstra H, Legislators craft alternative vision of sex education to counter abstinence-only drive, The Guttmacher Report on Public Policy, 2002, 5(2):1-3.
Slide 28: P.L , Aug. 22, 1996.
Slide 29: Dailard C, Abstinence promotion and teen family planning: the misguided drive for equal funding, The Guttmacher Report on Public Policy, 2002, 5(1):1-3.
Slide 30: Dailard C, Funding history for abstinence programs, memorandum, Washington, DC: AGI, 2003.
Slide 32: Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001; and Satcher D, The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, Rockville, MD: Office of the Surgeon General, 2001.
Slide 33: Kirby D, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: The National Campaign to Prevent Teen Pregnancy, 2001; and Satcher D, The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, Rockville, MD: Office of the Surgeon General, 2001.
Slide 34: Bearman PS and Bruckner H, Promising the future: virginity pledges and first intercourse, American Journal of Sociology, 2001, 106(4): ; Jemmott JB, Jemmott LS and Fong GT, Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial, Journal of the American Medical Association, 1998, 279(19): ; and Dailard C, Abstinence promotion and teen family planning: the misguided drive for equal funding, The Guttmacher Report on Public Policy, 2002, 5(1):1-3.
Slide 36: Boonstra H, Public health advocates say campaign to disparage condoms threatens STD prevention efforts, The Guttmacher Report on Public Policy, 2003, 6(1):1-2 & 14.